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Biomedical subjects

A K Gupta

Publications and source records attributed to A K Gupta.

At least 307 records · Page 17Linked to original sources
PubMed1999

Oral itraconazole therapy for superficial, subcutaneous, and systemic infections. A panoramic view.

The availability of the oral triazole agents itraconazole and fluconazole has revolutionized antifungal therapy. Although there are still some limitations and treatment failures, these agents have allowed for improved efficacy, increased safety, reduced morbidity, decreased mortality from systemic fungal disease, and a shift toward increased outpatient therapy for fungal infections that are not life-threatening. The treatment of superficial infections also has been enhanced by the development of effective intermittent and short-course regimens. Itraconazole exhibits broad-spectrum in vitro activity against several fungal organisms, including Trichophyton species, Candida albicans, Pityrosporum species, Aspergillus flavus, Aspergillus fumigatus, Blastomyces dermatitidis, Histoplasma capsulatum, Histoplasma capsulatum var duboisii, Sporothrix schenckii, and Cryptococcus neoformans. Animal model studies have confirmed the broad-spectrum in vivo activity of itraconazole. Multiple clinical studies and extensive clinical experience have substantiated the versatility of itraconazole, with good efficacy demonstrated in a wide variety of infections in humans. Itraconazole is approved for use in several countries for dermatomycoses, onychomycosis, oral-esophageal candidiasis, vaginal candidiasis, histoplasmosis, blastomycosis, aspergillosis, and fungal keratitis. Pulse therapy regimens for dermatomycoses and onychomycosis of the toenails or fingernails have been approved in several countries.

Administration, Oral↗
PubMed1999

Itraconazole oral solution for the treatment of tinea capitis using the pulse regimen.

A 7-year-old boy with Trichophyton tonsurans tinea capitis was cured following the administration of itraconazole oral solution. He had difficulty swallowing tablets or capsules, so the availability of the oral solution was particularly advantageous. The itraconazole was given once daily in a fasting state at a dosage of 3 mg/kg/day as a pulse lasting 1 week. The first two pulses were separated by 2 weeks and the second and third pulse by 3 weeks. The decision whether or not to administer the third pulse was guided by the presence of clinical symptoms and signs of tinea capitis just prior to the scheduled administration. The availability of the oral solution will enable more young children to be considered for treatment of tinea capitis with itraconazole than was possible when only tablets or capsules were available.

Administration, Oral↗
PubMed1999

The new oral antifungal agents for onychomycosis of the toenails.

OBJECTIVE: To review the use of the new oral antifungal agents, itraconazole, terbinafine and fluconazole for the treatment of onychomycosis of the toenails. BACKGROUND: Until about 10 years ago the two oral agents available to treat onychomycosis were griseofulvin and ketoconazole. Since then the new oral antifungal agents have superseded the traditional oral agents for the management of toenail onychomycosis. METHODS: Literature review. RESULTS AND CONCLUSION: Itraconazole, terbinafine and fluconazole have been used approximately 100 million times to treat superficial mycoses. These agents are more effective than the traditional antimycotics for the treatment of pedal onychomycosis; furthermore, the new agents have a broader spectrum of action than griseofulvin. In general, itraconazole, terbinafine and fluconazole have a favorable adverse-effects profile with drug interactions that are usually predictable and manageable. The new oral antifungal agents have a high benefit-to-risk ratio when used to treat toenail onychomycosis.

Administration, Oral↗
PubMed1999

Effects of a composite Indian herbal preparation on combat effectiveness in low-intensity-conflict operations.

The efficacy of a composite Indian herbal preparation (CIHP) in sustaining the mental performance of soldiers engaged in prolonged low-intensity-conflict operations has been evaluated. For this purpose, a cohort of 56 soldiers acted as volunteers in combat situations. After recording their initial responses to psychological tests such as the d2 test, the trail-making test, the serial addition test, the short-term memory test, and the Institute for Personality and Ability Testing Anxiety Scale, they were randomly given either CIHP or placebo in a double-blind fashion for 8 days while they performed their usual combat duties. The final 3 days of assignments included physically exhausting and life-threatening events. On day 8, they were withdrawn from combat duties and the psychological tests were readministered immediately. After 7 days of rest, the tests were repeated once again. The results indicate comparatively better performance immediately after the mission by the CIHP group. CIHP was effective at sustaining the mental abilities of soldiers in a low-intensity-conflict environment.

Adult↗
PubMed1999

Onychomycosis: predisposed populations and some predictors of suboptimal response to oral antifungal agents.

The population groups predisposed to onychomycosis and factors associated with a poor response to antifungal therapy may be subdivided into (a) genetic, (b) environmental, (c) systemic conditions, (d) local nail characteristics, and (e) other miscellaneous items. By paying attention to the scenarios that may lead to a suboptimal response to the therapy and a higher probability of relapse of the onychomycosis, it may be possible to improve the overall cost-effectiveness of treatments for onychomycosis. Besides attempting to achieve a cure when treating onychomycosis it is important to take steps to prevent reinfection with fungal organisms.

Antifungal Agents↗
PubMed1999

An IgM monoclonal antibody to Japanese encephalitis virus recognizing a cross-reactive epitope on nuclear histones.

An IgM class of monoclonal antibody (MAb) raised against 'envelope' (E) glycoprotein of Japanese encephalitis (JE) virus, cross reacted with nuclear histones, in addition to recognizing the viral antigen present in the cytoplasm of infected cells by indirect fluorescent antibody (FA) technique. The experiments on histone depletion by the acid treatment of uninfected PS (porcine kidney) cells, revealed the loss of nuclear immunofluorescence (IF) which was regained after the reconstitution of acid treated cells with histones, prior-to reacting with MAb NHA-2. The IgM MAb recognized specifically the viral antigens expressed on the surface of JE virus infected PS cells by a modified indirect FA. The adsorption of MAb NHA-2 with calf thymus histones (type II-AS) showed a comparative higher drop in the reactivity to JE virus (54.2% reduction) as compared to that against uncomplexed histones (33.3%) by ELISA, thus indicating a higher MAb affinity to the former. In contrast, the adsorption of MAb with chicken RBC nuclei resulted in comparatively more reduction in the reactivity to the uncomplexed histones (52.4% reduction) as against JE virus (37.5%), suggesting that DNA plays some role in modifying and presenting these epitopes. The cross-linkage of epitopes by glutaraldehyde treatment of JE virus antigen and histones showed a 2-fold and higher rise in the MAb reactivity as against those with unfixed or methanol fixed antigens (no cross-linkage), suggesting that the epitope is conformation dependent. Thus, histones seem to share a partial conformational homology with 'E' glycoprotein of JE virus and immune reaction with histones might lead to an autoimmune disorder.

Animals↗
PubMed1999

Cardiac function in hypothyroid children: effect of replacement therapy.

OBJECTIVE: To evaluate prospectively cardiac function in children with primary hypothyroidism before and after replacement therapy with L-thyroxine. DESIGN: Prospective clinical and laboratory cardiac evaluation of children with hypothyroidism before and after therapy. SETTING: Hospital based. SUBJECTS: 20 consecutive children aged 6 months - 14 years with primary hypothyroidism. METHODS: Assessment of cardiac status by clinical, radiological, ECG, echocardiography, M-mode and 2 dimensional echo-Doppler study and phonocardiography for systolic and diastolic functions and structural anomalies. RESULTS: Indices of myocardial contractility like ejection fraction (EF), velocity of circumferential fibre shortening (VCF) did not change with therapy. However, systolic time intervals, both left ventricular (before therapy 0.32+/-0.03 msec; after therapy 0.25+/-0.03 msec; p <0.001) showed a significant change. In diastolic functions, isovolumic relaxation time fell from 62+/-9 msec before therapy to 50+/-5 msec after therapy (p <0.001). Pericardial effusion was found in 10 children before treatment which disappeared in 7 following therapy. CONCLUSION: Subtle evidence of alteration of myocardial function is thus seen in children with primary hypothyroidism which reverses with treatment.

Adolescent↗
PubMed1999

Antibiotic prophylaxis in elective cholecystectomy: a randomized, double blinded study comparing ciprofloxacin and cefuroxime.

A prospective, randomised and double blind study was undertaken to compare the prophylactic efficacy of ciprofloxacin and cefuroxime in 155 patients undergoing elective cholecystectomy. Patients with past history of jaundice or presence of jaundice, diabetes mellitus, common bile duct stones and previous biliary tract surgery were excluded. Patients were allocated to the following groups: group A-no antibiotic (n = 30); group B-ciprofloxacin (200 mg i/v before surgical incision and a second dose after 12 hrs) (n + 45); group C-ciprofloxacin given only post operatively (200 mg i/v, 12 hourly X 2 days followed by oral 500 mg twice daily X 3 days) (n = 35); group D-cefuroxime (750 mg i/v before surgical incision and a second dose after 12 hrs) (n = 45). Efficacy of the antibiotic was defined as a patient being free of post operative wound infection. Maximum numbers of infection occurred in group A (26.67%) and group C (25.71%). The incidence of wound infection was significantly lower when ciprofloxacin was used as prophylaxis (group B) than when used post operatively (group C) only (P < 0.05). Patients who received ciprofloxacin (group B) and cefuroxime (group D) as prophylaxis had significantly reduced incidence of infection (4.44% and 6/67% respectively); no statistically significant difference was found between these groups. Ciprofloxacin could be used as prophylactic antimicrobial in elective cholecystectomy in developing countries because of its effectiveness, economy and ready availability.

Adolescent↗
PubMed1998

RNA polymerase of vesicular stomatitis virus specifically associates with translation elongation factor-1 alphabetagamma for its activity.

An RNA-dependent RNA polymerase is packaged within the virions of purified vesicular stomatitis virus, a nonsegmented negative-strand RNA virus, which carries out transcription of the genome RNA into mRNAs both in vitro and in vivo. The RNA polymerase is composed of two virally encoded polypeptides: a large protein L (240 kDa) and a phosphoprotein P (29 kDa). Recently, we obtained biologically active L protein from insect cells following infection by a recombinant baculovirus expressing L gene. During purification of the L protein from Sf21 cells, we obtained in addition to an active L fraction an inactive fraction that required uninfected insect cell extract to restore its activity. The cellular factors have now been purified, characterized, and shown to be beta and gamma subunits of the protein synthesis elongation factor EF-1. We also demonstrate that the alpha subunit of EF-1 remains tightly bound to the L protein in the inactive fraction and betagamma subunits associate with the L(alpha) complex. Further purification of L(alpha) from the inactive fraction revealed that the complex is partially active and is significantly stimulated by the addition of betagamma subunits purified from Sf21 cells. A putative inhibitor(s) appears to co-elute in the inactive fraction that blocked the L(alpha) activity. The purified virions also package all three subunits of EF-1. These findings have a striking similarity with Qbeta RNA phage, which also associates with the bacterial homologue of EF-1 for its replicase function, implicating a possible evolutionary relationship between these host proteins and the RNA-dependent RNA polymerase of RNA viruses.

HeLa Cells↗
PubMed1998

Intra-pancreatic splenic artery pseudoaneurysm. A rare complication of chronic calcific pancreatitis.

The authors present the case of a 12-year-old boy with a history of chronic upper abdominal pain. Based on ultrasonography, endoscopic retrograde cholangio-pancreatography, and computerized tomography, a diagnosis of chronic calcific pancreatitis with dilation of the main pancreatic duct and a pseudocyst of the proximal pancreas was made. At surgery, in addition to confirmation of the above findings, a pseudoaneurysm arising from the splenic artery was found in the head and body of the pancreas. Pancreaticoduodenal resection including the pseudoaneurysm was performed. Postoperatively the child developed diabetes, which is easily managed with small doses of insulin.

Aneurysm, False↗
PubMed1998

Acute renal failure in bilateral urinary tract tuberculosis.

A case of bilateral urinary tract tuberculosis presenting with acute renal failure is reported. It is believed to be the first reported instance of the disease presenting in this form. The patient was managed with preliminary high diversion followed by bilateral replacement of the ureters with ileal loops that were anastomosed end-to-side and then implanted into the bladder.

Acute Kidney Injury↗
PubMed1998

Somatic growth and renal function after unilateral nephrectomy for Wilms' tumor.

Solitary kidneys in renal donors and patients who have undergone unilateral nephrectomy for malignant disease have been reported to undergo hyperfiltration injury. This study was undertaken to evaluate the somatic growth and development of followed-up patient after Wilms' tumor to evaluate their renal function and identify any evidence of injury in the remaining kidney. The growth and development of all the children was found to be normal, as was DTPA clearance. Microalbuminuria in 24-h urinary collections was detected in 84% of the patients, indicating evidence of hyperfiltration injury. This study highlights the need for close monitoring of the renal function of long-term follow-up patients after Wilms' tumor in addition to the routine monitoring for tumor recurrence.

Albuminuria↗
PubMed1998

Treatment of tinea capitis with itraconazole capsule pulse therapy.

BACKGROUND: The number of newly diagnosed cases of tinea capitis in children appears to be on the rise, particularly in urban centers. OBJECTIVE: The purpose of this study was to assess the effectiveness, safety, and compliance of itraconazole pulse therapy for tinea capitis. METHODS: Fifty subjects (48 children [less than 18 years of age] and 2 adults) with tinea capitis were treated with pulse itraconazole in a multicenter evaluation. Each pulse lasted 1 week, with 2 weeks between the first two pulses and 3 weeks between the second and third pulses. The decision to administer a second or third pulse was determined by the response of the subject at the time that the next pulse was due. During the 1-week pulse of active therapy, itraconazole (5 mg/kg/day) was dosed as follows: more than 40 kg, 200 mg per day (two capsules per day); 20 to 40 kg, 100 mg per day (one capsule per day); and 10 to 19 kg, 50 mg per day (one half of a capsule per day). The duration of the study was 12 weeks with mycologic evaluation at this time. Subjects who were classified as treatment failures at 12 weeks after the start of therapy were given the option of receiving an additional 1-week pulse of active therapy, with 3 weeks between successive pulses. RESULTS: The causative organisms were Trichophyton tonsurans (41 subjects), T violaceum (7), T. soudanense (1), and T rubrum (1). Thirteen subjects were lost to follow-up, with 37 subjects (35 children and 2 adults) available for evaluation 12 weeks after the start of therapy. At this time, cure (clinical and mycologic) was observed in 30 (81%) of 37 subjects. When the tinea capitis was mild, cure was obtained after one pulse in two subjects and after two pulses in five subjects. With tinea capitis of moderate extent, complete cure was obtained after one pulse in one subject, two pulses in eight subjects, and after three pulses in seven subjects. When tinea capitis was severe, two and three pulses produced complete cure in one and six subjects, respectively. Of the seven subjects whose conditions failed to respond (three subjects with moderate disease and four subjects with severe disease), five subjects chose to receive extra itraconazole. Clinical and mycologic cure was observed after four pulses in four subjects and after five pulses in one subject. There were no associated clinical adverse effects with itraconazole therapy. CONCLUSION: With tinea capitis, itraconazole pulse therapy is effective and safe and is associated with high compliance. The pulse regimen enables the duration of treatment to be individualized, according to the extent of disease and its rate of resolution.

Antifungal Agents↗